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Summary
To investigate long COVID-19 syndrome (LCS) pathophysiology, we performed an exploratory study with blood plasma derived from three groups: 1) healthy vaccinated individuals without SARS-CoV-2 exposure; 2) asymptomatic recovered patients at least three months after SARS-CoV-2 infection and; 3) symptomatic patients at least 3 months after SARS-CoV-2 infection with chronic fatigue syndrome or similar symptoms, here designated as patients with long COVID-19 syndrome (LCS). Multiplex cytokine profiling indicated slightly elevated pro-inflammatory cytokine levels in recovered individuals in contrast to patients with LCS. Plasma proteomics demonstrated low levels of acute phase proteins and macrophage-derived secreted proteins in LCS. High levels of anti-inflammatory oxylipins including omega-3 fatty acids in LCS were detected by eicosadomics, whereas targeted metabolic profiling indicated high levels of anti-inflammatory osmolytes taurine and hypaphorine, but low amino acid and triglyceride levels and deregulated acylcarnitines. A model considering alternatively polarized macrophages as a major contributor to these molecular alterations is presented.
The team found that profound alterations in many immune cell types often persisted for weeks or even months after SARS-CoV-2 infection. These problems resolved themselves very differently depending on the type of immune cell. Some recover while some remain markedly abnormal, or show only limited recovery, even after systemic inflammation has resolved and patients have been discharged from hospital.
Summary: Autopsy tissue samples of 44 people who died of COVID-19 showed SAR-CoV-2, the virus responsible for coronavirus, spread throughout the body and to the brain, with traces of the virus lingering for 8 months.
Source: University of Minnesota
An analysis of tissue samples from the autopsies of 44 people who died with COVID-19 shows that SAR-CoV-2 virus spread throughout the body—including into the brain—and that it lingered for almost eight months.
The study was published in Nature.
Scientists from the National Institutes of Health (NIH) tested samples from autopsies that were performed from April 2020 to March 2021. They conducted extensive sampling of the nervous system, including the brain, in 11 of the patients.
RNA and viable virus in various organs
All of the patients died with COVID-19, and none were vaccinated. The blood plasma of 38 patients tested positive for SARS-CoV-2, three tested negative, and plasma was unavailable for the other 3.
We show that SARS-CoV-2 is widely distributed, predominantly among patients who died with severe COVID-19, and that virus replication is present in multiple respiratory and non-respiratory tissues, including the brain, early in infection. Further, we detected persistent SARS-CoV-2 RNA in multiple anatomic sites, including throughout the brain, as late as 230 days following symptom onset in one case.
Despite extensive distribution of SARS-CoV-2 RNA throughout the body, we observed little evidence of inflammation or direct viral cytopathology outside the respiratory tract. Our data indicate that in some patients SARS-CoV-2 can cause systemic infection and persist in the body for months.
The McMaster University study determined that patients surveyed were otherwise healthy and had no pre-existing autoimmune conditions or other underlying diseases.
Canada’s health agency notes that post-COVID-19 condition, or long COVID, may occur in some people weeks or months after initial infection. People who have been hospitalized or who needed intensive care during recovery are also likely to be at greater risk of experiencing longer-term effects from the virus.
Mukherjee said patients with long COVID symptoms should see a rheumatologist instead of being treated by respirologists or infectious disease specialists, as the latter do not specialize in autoimmunity.
“Sometimes, while the body is fighting the virus, the immune system gets so amped up that, in addition to making antibodies that kill the virus, it can produce those that attack the host,” said Mukherjee.
Interpretation Persistently positive ANAs at 12 months post-COVID are associated with persisting symptoms and inflammation (TNFα) in a subset of COVID-19 survivors. This finding indicates the need for further investigation into the role of autoimmunity in PASC.